Thursday, November 29, 2012

The boys of North Marshall Middle
School of Benton, Ky., after winning
a Christmas tournament last year.

Beth Musgrave of the Lexington Herald-Leader reports that the state Task Force on Interscholastic Athletics at the Middle School Level announced its preliminary recommendations this week to address concerns about young athletes' health and safety. It seems that middle school sports in Kentucky have never had the advantage of being governed by a unified code of rules and policies like their counterpart in high school sports. This has led to a confusing mish-mash of guidelines that the legislature is setting out to get right in the coming year.

Preliminary task forcerecommendations include requiring all middle school teams to follow high school rules on physical exams, medical coverage, concussions and practicing during extreme heat, and requiring the tracking of injuries and incidents for all sports. The task force also suggested that the Kentucky Board of Education look to create a single governing body, like the Kentucky High School Athletics Association that governs high school sports, to oversee all middle-school sports. Wilson Sears, executive director of the Kentucky Association of School Superintendents and a task force member, told Musgrave that the recommendations represent "real progress."
(Read more)

Take no solace from The Economist, which proclaims in its yearly analysis-and-prognostication issue that this is the year world leaders will take on worldwide obesity because, writes Charlotte Howard, "they will realize something must be done."

So, no, it is not just you, Kentucky. In fact, Howard, the health-care correspondent for the magazine, writes that 30 percent of Mexico's adult population is obese. That is precisely the same percentage of Kentuckians that were considered obese by a Robert Wood Johnson Foundation and Trust for America's Health analysis released in August. (We ranked sixth fattest state nationwide.) It is also the same percentage of Chinese adults that are, as Howard put it, "too wide" -- a term that Howard uses here to include the overweight as well as the obese.

But there is no room to crow here. Kentucky is far ahead of the trend. Only 12 percent of the world counts as obese today. We beat that two and half times over. (The number of Kentuckians who were merely overweight was not calculated or included in the figures in the study.) A study released in September by the same group found that if trends continue, 60 percent of Kentuckians will be obese by 2030. The World Health Organization's estimate of the world's obesity was at 15 percent by 2020.

The Economist folks favors an approach that a democratic path to better health and fiscal sanity, given the health care cost ramifications of obesity. They like a tax on soda -- it's pure sugar, no real nutrition. They like subsidies to make fresh produce cheaper. And they like better school lunches and labeling, labeling, labeling so consumers will make better choices.

A drug widely used against heart disease can increase the possibility of death when used by patients with atrial fibrillation, a common heart rhythm problem, according to a study by University of Kentucky researchers. Digoxin, a derivative of the foxglove plant, is an old yet controversial heart drug. Though considered obsolete by some, it is still widely used.

The study, published in European Heart Journal, analyzed data from 4,060 atrial-fibrillation patients. It was led by Dr. Samy Claude Elayi, associate professor of medicine at UK HealthCare's Gill Heart Institute. The results of the study indicate that further review by the Food and Drug Administration is warranted to determine if stronger warnings about its use should be required. (Read more)

Wednesday, November 28, 2012

The Northern Kentucky Chamber of Commerce is planning to lobby the state for more funding for heroin treatment after receiving reports from business and law enforcement about the breadth and depth of the drug problem in the region. Terry DeMio of the Cincinnati Enquirer reports that the chamber's Geraldyn Isler says the area has the “highest volume of people in the state needing substance abuse treatment but is receiving the least amount of funding.”

According to the Northern Kentucky Drug Strike Force, 63 percent of heroin possession and trafficking prosecutions in Kentucky are in Boone, Kenton and Campbell counties, the three urbanized counties in the region.
A 2007 University of Kentucky study that shows that the region led the commonwealth in people needing substance abuse treatment, but that it also received the lowest per capita funding from staff coffers for those mental health services for more than a decade.

The chamber told DeMio there are many "hidden costs" to such abuse. Among those costs: increased employee absenteeism, tardiness, job-related injuries and errors. It also notes employee-employer conflict, greater health-insurance costs and crime as likely outcomes of heroin in the region. (Read more)

There could be other requests for more funding for heroin treatment. This week the London Police Department made the first known arrests for heroin trafficking in Laurel County, The Sentinel-Echoreports.

Two Central Kentucky mothers participated in a Duke University-led study published today that shows that a vast majority of U.S. couches contain potentially toxic flame retardants that pose risks to humans. Wendy Koch of USA Today reports that the risks occur when the chemicals migrate from furniture foam into house dust.

The closely watched study revealed that more than 40 percent of the foam in the 102 couches tested contained the carcinogen chlorinated Tris, a substance that was ordered removed from children's pajamas 35 years ago. Another 17 percent of the couches contained pentaBDE, a globally banned substance. More than 85 percent were treated with a potentially toxic flame retardant, which researchers and experts say amounted to more than a pound of chemicals per couch. Flame retardants have been linked to hormone disruption, cancer and neurological toxicity in hundreds of animal and human studies. A fire specialist told Koch that the chemicals are not effective in suppressing fires.

The two Kentuckians, both women concerned about their family's health, sent samples from their couches to be analyzed and both expressed horror at the findings. Dr. David A. Atwood, a chemist at the University of Kentucky, said a systematic shift in chemical regulation is necessary to protect public health. “We have made an enormous mistake assuming that a chemical should be used freely until it is determined to have adverse health effects, rather than taking the position that all chemicals should be avoided unless it is absolutely certain that the chemical is safe."
In New York, legislation is already in motion that would ban chlorinated Tris. According to the Kentucky Environmental Foundation, efforts will begin next year to restrict the toxic chemical. (Read more)

Tuesday, November 27, 2012

A study at the University of Louisville James Graham Brown Cancer Center designed to make radiation treatment more accessible to women who face obstacles such as distance, transportation problems and time constraints is proving promising. The idea is to cut daily trips to the cancer center to once a week, says Dr. Anthony Dragon, a radiation oncologist at U of L. It also has the added benefit of cutting treatment costs by better than half.

Laura Ungar of The Courier-Journal in Louisville reports that
Dragun led a previous study that found that "about a third of Kentucky women with early-stage breast cancer didn’t get recommended radiation treatments after lumpectomy surgery.
Among those least likely to get radiation were rural Kentuckians, the elderly, African Americans and women in the Appalachian region of the state.
Women who did not get recommended radiation were 60 percent more likely to die during the time they were studied."

Dragun told Ungar that the folks at U of L were not satisfied with just gathering those numbers, they wanted solutions to the problem. Dragun said the new experimental regimen is yielding good results, with women who get weekly radiation reporting similar levels of side effects as those getting radiation every day.
Ungar notes that some outside experts say the approach does seems promising, but one critic was concerned about breast appearance results after the once-a-week treatments.

According the National Cancer Institute, more than 3,070 new cases of breast cancer were diagnosed in Kentucky in 2009 and was responsible for 614 deaths. (Read more)

A new report out today in the journal Pediatrics warns that, on average, 31 children a day are transported to U.S. emergency departments for treatment of bounce-house injuries, including fractured bones and muscle damage.
"If this was an infectious disease, we'd call it an epidemic and it would be on the front pages all over the country," said study co-author Dr. Gary A. Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. (Associated Press photo)

Randy Dotinga of HealthDay reports that in the 15-year period between 1995 and 2010, the rate of bounce-house injuries jumped 15-fold, with the number escalating in the last few years of the study.
In the new study, published online Monday and in the December print issue of Pediatrics, researchers found the most common bounce-house injuries were fractures, strains and sprains. Concussions and cuts were more common in boys. The average age of those hurt was 7.5 years old. (Read more)

Monday, November 26, 2012

Expanding Medicaid to people making up to 138 percent of the poverty level under federal health reform and its heavy subsidies would cost Kentucky about 5 percent more for Medicaid over the next 10 years than doing nothing, the Kaiser Family Foundation said in a state-by-state analysis today.

According to the study done by the Urban Institute for the foundation's Commission on Medicaid and the Uninsured, the state would spend $25.1 billion from 2013 to 2022 if it and no other state expanded the program. If all states expanded it, Kentucky's cost would be $26.4 billion, the study estimated.

Under the Patient Protection and Affordable Care Act, the federal government would pays the full cost of the expansion from 2014 to 2016. The federal government’s share would drop to 95 percent in 2017 and to 90 percent by 2020. In the 2013-14 fiscal year, the state budget calls for $1.48 billion in state funds to be spent on Medicaid benefits. The federal government pays about 72 percent of the program's cost in Kentucky.

In human terms, the report says the law will reduce the number of people in Kentucky without health insurance in 2022, no matter what happens. It says that if the act had never passed, 740,000 Kentuckians would have been uninsured in 2022. It will reduce that number to 513,000 even if Medicaid is not expanded anywhere. If all states expand Medicaid, the number of uninsured Kentuckians would drop to 332,000, the study estimates.

The Kaiser report is an update of a study done before the U.S. Supreme Court ruling ruled that the law was constitutional but made Medicaid expansion optional for states. So far, eight states have indicated their unwillingness to participate in the expansion, though more are expected to opt out but are waiting until legislatures return in January to discuss the matter.

Thursday, November 22, 2012

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

Wednesday, November 21, 2012

As of Jan. 1, the Christian County Health Department will not provide contraceptives or cancer screening to indigent patients if they do not reside in the county. Nick Tabor of the Kentucky New Era reports the department will provide those services to other counties' residents if the county in which they reside has signed a contract with Christian County before the Jan. 1 deadline agreeing to repay Christian County for those services. Tabor writes that the policy is not applicable to those services that are covered by state or federal government reimbursements.

The health department's move was prompted by a budget deficit that is close to $200,000, some of it traceable to a lack of reimbursement for contraceptive care. Mark Pyle, director of the department, told Tabor that residents of both Todd and Trigg counties often seek services in Christian County and Christian county taxpayers foot that bill. Pyle explained that there’s nothing in state law saying the health departments have to serve anyone who comes in, regardless of residence.

The death rate from heart disease is nearly twice as high in Perry County (Wikipedia map) as in Kentucky as a whole, so there's no better time than now to announce that the University of Kentucky Medical Center is close to finalizing a three-year agreement with Hazard Appalachian Regional Healthcare Medical Center to provide continuing care, outreach and education to local physicians and county residents, including more and better information about heart-healthy food choices. Bailey Richards of the Hazard Herald reports that this last task is daunting, particularly since availability of good food is an issue in remote parts of the county.

Richards writes that a 2011 study of the heart-healthy food options in Perry County "showed that the area severely lacks low-fat and low-sodium options." Kevin Luley, a registered nurse at the UK Medical Center and winner of the "Heart Health in Rural Kentucky" grant, surveyed all of the restaurants and grocery stores in Perry County and found that most do not have many off-the-shelf options for a healthy diet.
Of all of the items available at the restaurants in Perry County, fewer than 6 percent were considered healthy. (Residents can consult their own smartphones for that information. It should also be posted or available upon request.) Of a standard list of produce items, on average only 60 percent were found at the local grocery stores, Luley found. (Read more)

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)

Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

Doctors at Louisville's University Hospital are expressing concerns that the partnership with KentuckyOne Health and the Catholic health rules that come with that merger might affect patient care. Assurances that their concerns are unfounded have been coming from KentuckyOne's majority owner, Denver-based Catholic Health Initiatives. Anxiety over doctors' medical freedom to treat patients as they feel is necessary is being fueled as staff and physicians are being asked to "respect" Catholic health directives, The Courier-Journal reports.

Sheila Reynertson, advocacy coordinator for the New York-based MergerWatch Project, who tracks secular-religious hospital mergers, told The C-J's Laura Ungar that such language puts doctors in "a difficult position."
For instance, she explains, "cancer doctors may wonder about prescribing birth control to prevent pregnancy, she said.
Catholic directives include a ban on sterilization, abortions, and euthanasia and say Catholic health institutions can't "promote or condone contraceptive practices."
Gary Mans, spokesman for the U of L Health Sciences Center, said he doesn't believe doctors and staff will feel constrained by the directives. (Read more)

Tuesday, November 20, 2012

The lobby for makers of over-the-counter drugs, which has fought laws to tighten controls on sale of cold medicine that is used to make methamphetamine, is starting a public-education campaign to discourage evasion of the system that tracks purchases of pseudoephedrine. The targeted states are Kentucky and Alabama, which could be key to preventing passage of laws like the one in Mississippi, which requires a prescription for pseudoephedrine. UPDATE, 4/19/13: Missouri has been added.

The Consumer Products Healthcare Association rolled out the campaign in Alabama last month. It joined with the Kentucky Pharmacists Association and the Kentucky Retail Federation yesterday to announce the program in Kentucky, and won the blessing of its primary adversary in the state's legislative battle, Senate Republican Leader Robert Stivers of Manchester. Also on hand at Wheeler's Pharmacy in Lexington was Democratic Gov. Steve Beshear, who had stayed out of the fight until he signed the bill.

Stivers, who is in line to become Senate president, was asked if the drug makers' move signaled a truce in the battle. He indicated that he would wait to see the impact of this year's law, which reduced the amount of pseudoephedrine that can be bought during one a month, before trying to tighten it. "Let's look at the history and see what happens," he said. Earlier, he said: "I appreciate the fact that they're coming here in a very conciliatory way, a very open way, to say we all know there is a problem."

Beshear noted that fewer meth labs have been found in Kentucky this year, but said the success of the law depends on educating the public: "As laws are passed, criminals adapt and find new ways of getting around them."

Preventing that is the goal of CHPA's "Anti-Smurfing Campaign," named for the practice of meth makers using others, "smurfs," to buy pseudoephedrine for them. Beshear noted that the new law makes smurfing a felony, and said the posters are "designed to make smurfers think twice" and "think of the moral and criminal consequences of their actions." He toldcn|2 Politics, "I think will be a good deterrent in this situation."

CHPA's director of state government affairs, Carlos Gutiérrez, said the posters were tested in 2011 with focus groups of Kentuckians and strike a balance of educating potential smurfers without alarming law-abiding buyers of pseudoephedrine.

In its efforts to kill Stivers' prescription bill during the 2012 legislative session, CHPA spent more than any other lobbying group has ever reported spending on a legislative session, and that did not include hundreds of thousands of dollars it spent on radio commercials urging listeners to lobby legislators about the bill. Lobbies in Kentucky do not have to report what they spend on such indirect lobbying. Guiterrez was asked if CHPA would do that, and he said he would look into it.

University of Kentucky surgeons performed Kentucky's first combined heart-lung transplant in 15 years this summer, UK announced today.

Dawn Nelson, 29, of Louisville, received two lungs and a heart from the same donor in one procedure at the Albert B. Chandler Medical Center on July 7. She and her parents discussed it with Courier-Journal reporter Laura Ungar in this video by The C-J's Kylene White:

For Ungar's story, click here. Combined heart-lung transplants are rare; only 27 were performed nationwide in 2011. They are generally performed on younger patients who have a fatal disease and cannot be treated with medication or other interventions.

Nelson was diagnosed with systemic lupus erythematosus at 17 and rheumatoid arthritis at 22. Four years ago, she developed pulmonary hypertension, fatal without timely treatment. The disease destroyed her lungs, and her heart began to fail when it could no longer push blood into them.

Dr. Wesley McConnell, a transplant pulmonologist with Kentuckiana Pulmonary Associates in Louisville, began caring for Dawn two and a half years ago at KPA's Pulmonary Hypertension Center. After she didn't respond to drug therapies, McConnell referred Dawn to UK May 11 for a transplant evaluation.
"Dawn was extremely ill and it became clear that her only chance for survival would be a heart-lung transplant," he said. "I knew that UK was her best option because they had the most experienced team in the state."

Dr. Charles Hoopes, director of the UK Transplant Center, performed the surgery, only the seventh such procedure to be performed at UK since it began transplantation in 1964. The last time UK performed this surgery was 1996.
"Although the surgery itself is relatively simple, combined heart-lung transplants are rare because they require three donor organs and are reserved for patients who are extremely ill with heart and lung failure," said Dr. Jay Zwischenberger, chair of the UK Department of Surgery. "They also require a great deal of infrastructure and support to perform successfully. At UK, we have that team in place, and moving forward we expect to perform one or two of these combined transplants per year."

More than four months after her surgery, Nelson continues to improve and grow stronger. Dr. Enrique Diaz, medical director for lung transplantation, and Dr. Navin Rajagopalan, medical director of cardiac transplantation, both provide followup care for her at UK, and she continues to see McConnell in Louisville.
"Dawn is doing quite well. At the time of transplant, she was so sick she only weighed about 80 pounds," Rajagopalan said. "Now, she feels well, is gaining weight, and is able to do things that she had not been able to do for years.”

Nelson's collaborative treatment is a prime example of the partnership UK is trying to cultivate among Louisville and Lexington doctors, said Dr. Michael Karpf, UK executive vice president for health affairs: “Our goal is to continue to provide highly advanced subspecialty care such as Ms. Nelson’s complex transplant to patients like her who otherwise would either have to leave the commonwealth or, worse, not receive the treatment needed.”

In November 2010, UK in collaboration with Norton HealthCare opened up an outreach Transplant and Specialty Clinic at Norton Audubon Hospital to provide comprehensive pre- and post-transplant care for patients. The partnership ensures that patients like Nelson will not have to leave the state to receive complex acute care or followup treatment, a UK press release said.

Monday, November 19, 2012

Many Kentucky parents' perception of their children's health doesn't match statistics, suggesting that many health problems are going undetected or untreated.

That is the upshot of the Foundation for a Healthy Kentucky's first Kentucky Parent Survey, conducted by the University of Virginia's Center for Survey Research this summer and released today.

Only 4 percent of Kentucky parents said a health professional had told them their child was obese, but the National Survey of Children's Health in 2007 found that almost 37 percent of Kentucky children were obese.

Just 5 percent of Kentucky parents said they had been told that their child had depression or anxiety, but about 25 percent of children 13 to 18 will have struggled with anxiety and 11 percent will have battled depression, according to a 2010 national study. And a recent study found that Kentucky teens were more likely than the national average to have attempted suicide.

About 17 percent of Kentucky parents reported that their child had decayed teeth or cavities, but a national survey of third graders in 2001-02 revealed that 35 percent had untreated dental issues.

Only 3 percent of parents said their child was diagnosed with a hearing problem, but 15 percent of children nationally have measurable hearing loss. And 14 percent reported being told their child had a vision problem, but about one in four preschoolers nationally have vision issues.

Parents also seem not to get enough advice from health care providers about how to treat their children's health issues, even though there are high rates of children suffering from tooth decay, vision problems, asthma, ADHD, depression/anxiety, obesity, hearing impairment and diabetes, the survey found.

While 92 percent of parents said their child had a regular doctor, just 80 percent said their child had a regular dental care provider. And a 74 percent majority of parents surveyed said they were always encouraged by their child's healthcare provider to ask questions during visits. "The exceptions are worth noting," said Susan Zepeda, president and CEO of the foundation. "If three in four parents said their child's provider always encouraged questions, this means that one in four were not always encouraged to ask questions." (Read more)

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

Children who attend day care regularly are 50 percent more likely to be overweight than those who stay home with parents, according to a new University of Montreal study in Quebec. Lead researcher Marie-Claude Geoffroy said the disparity "cannot be explained by known risk factors such as socioeconomic status of the parents, breastfeeding, body mass index of the mother, or employment status of the mother."

Researchers studied more than 1,600 families with children born in 1997 and 1998 in Quebec, a sample that was representative of the majority of kids in the province. Mothers were interviewed about their children's care at ages 1.5, 2.5, 3.5 and 4. Children were put into groups based on the type of care they received most. Researchers concluded that 65 percent of children spent most of their time in day care. Just 19 percent were cared for mostly by a parent.

Researchers found no clear explanation for the weight disparities, but they argued that day care has the potential to reduce weight problems in children through promotion of physical activity and healthy eating. (Read more)

Friday, November 16, 2012

We're not just getting fatter, Kentucky, we're becoming chronically ill because of it. According to the Centers for Disease Control and Prevention, the rate of diagnosed diabetes in Kentucky has increased dramatically in the last decade and a half.

In Kentucky, 9.3 percent of adults reported having been diagnosed with Type 2 diabetes in 2010, up from just 3.6 percent in 1995, according to response to the Behavioral Risk Factor Surveillance System, an ongoing national telephone survey. (Data from 2011 were not compared because the survey methodology changed.)

The figure is undoubtedly less than the actual percentage of Kentuckians with diabetes; nationally, 18 million people say they have been told they have the disorder, and another 7 million are estimated to have it but not be diagnosed. In 1958, the national rate of diagnosed diabetes was 1 percent; now it's 8.2 percent. Not surprisingly, Mississippi, the state with the largest proportion of
residents who are obese, has the highest diabetes rate, at nearly 12
percent.

The biggest jump in diagnosed diabetes from 1995 to 2010 was in Oklahoma, where it more than tripled. The South, as a region, had the most frightening numbers, almost one in 10 adults. That was more than double the rate in 1995. Several Northern states saw rates more than double, too, including Washington, Idaho, Montana, Wyoming, South Dakota, Minnesota, Missouri, Ohio and Maine.

"The rise in diabetes has really gone hand in hand with the rise in obesity," CDC report lead author Linda Geiss told The Associated Press.
Diabetes is a disease in which the body has trouble processing sugar. Even with medications to help control it, it can cause damage to the kidneys, circulation and nervous system. It is the nation's seventh leading cause of death. (Read more) To read the CDC report, go here.

Like most states, Kentucky showed a drop in reported cigarette smoking among 12- to 17-year-olds from 2002 to 2010, according to a report by the Substance Abuse and Mental Health Services Administration.

Nationwide, teenagers' reported "current use" of cigarettes dropped from 12.6 percent to 8.7 percent. In Kentucky, that decline was even more significant, plummeting from 17.6 percent in 2002 to 11 percent in 2010. The 2002 rate was third in the nation; the latest one is sixth. The surveys defined "current use" as smoking in the past month. (Click on map for larger version)

Strangely, the data showed that during the same period, teens' perception of risk from cigarette smoking remained unchanged in Kentucky and most other states. Tobacco use is the leading cause of premature and preventable death in the United States. (Read more) To read the full report, go here.

Wednesday, November 14, 2012

The University of Louisville and KentuckyOne Health have reached a partnership agreement that will leave the resolution of any "moral roadblocks" up to a higher authority. U of L President James Ramsey said the partnership will allow the hospital board to continue its control over the public entity, a principle that scuttled an earlier deal with Catholic Health Initiatives, which then formed KentuckyOne with Jewish Hospital. Gov. Steve Beshear signed on to the agreement, after killing the first one.

The goals of a public institution that provides all women's health services -- including reproductive and end-of-life care -- were not the same goals of those espoused by the Roman Catholic Church. The new agreement seems to have solved that issue by continuing to allow the hospital's pharmacy and Center for Women and Infants and to provide the same services as they did before, reports Laura Ungar of The Courier-Journal. The services will be provided by the same people as currently, the partners said. This includes all reproductive services.

The Archdiocese of Louisville said in a statement that it was not part of the negotiations but that there were no more “moral roadblocks” to its continued official recognition of KentuckyOne as a Catholic entity. The archdiocese said the partners involved “have committed to respecting one another’s traditions, missions, and values, including our own Ethical and Religious Directives for Catholic Health Care Services.”
(Read more)

Health professionals and other employees at Kosair Children's Hospital and the University of Louisville pediatrics unit were given an unusual tool this week when it was announced that their facilities are now No-Hit Zones. A program developed to maintain a calm, safe and caring environment for children and their parents, the No-Hit Zone initiative works to educate staffers on how to keep everyone on the ward safe from those who would lose their tempers while everyone around them is already in a stressful situation.

The policy is quite clear. No adult shall hit another adult. No adult shall hit a child. No child can hit an adult. And no child can hit another child while in the hospital environment.

The Kosair Children's, Kosair Children's-Brownsboro and U of L hospitals are now among only 30 children’s hospitals nationwide to implement the No-Hit Zone program. The Louisville effort has been led by Erin Frazier, M.D., FAAP, associate professor of pediatrics at the Uof L Children & Youth Project, and the Kosair Children’s Hospital Child Abuse Task Force, which Dr. Frazier chairs.

In 2010 the average number of dispensed outpatient antibiotic prescriptions was 801 per 1,000 Americans. In Kentucky it was1,197. The darker the state, the higher the rate. (CDC map)

Americans, especially Kentuckians, are taking too many antibiotics and that is contributing to the decline in the drugs' effectiveness, says a study by a group associated with the Centers for Disease Control and Prevention.

The study found that, in 2010, the five states with the highest antibiotic use were Kentucky,
West Virginia, Tennessee, Mississippi and Louisiana. Such misuse is already showing up, reports USA Today, as lab reports show urinary tract infections were 30 percent more likely to resist antibiotic treatment in 2010 than in 1999.

Dr. Robert Salley, executive director of
cardiovascular services for KentuckyOne Health in the Lexington market, told Cheryl Truman of the Lexington Herald-Leader that the overuse of
antibiotics might reflect the state's problem with prescription pain
pills.
Many Kentuckians are used to "that culture of availability, that culture
of not making appropriate use of the physician-patient relationship,"
he said. Experts have also noted that states that have lower rates of antibiotic use have spent money and time educating their residents about the dangers of overuse. Kentucky has not done that. (Read more)

Meanwhile, the Pew Health Group has released a study showing that 87 percent of Americans have a basic understanding of what antibiotics do, but many did not understand that antibiotic resistance was a major health issue and will only become more problematic in the future. Forty-one percent of Americans said they have never heard of the issue. For more information on that study, go here.

For the fifth year in a row, the preterm birth rate in the United States has dropped. Which is great news. But Kentucky again had a significantly high smoking rate for expectant mothers -- at 32.2 percent, putting us behind only West Virginia (at 36 percent) of pregnant women who gave birth preterm and smoked.

Being born before full term puts babies at undue risk. Still, nearly half a million babies in the United States are born prematurely, many unnecessarily, according to the March of Dimes' 2012 Premature Birth Report Card. Serena Gordon of HealthDay reports that "those risks include breathing difficulties, heart defects and bleeding in the brain. Some conditions are only temporary while others can persist." A premature birth is anything that occurs before 37 weeks gestation. Maternal smoking is a major factor respiratory difficulties for the child and in an inability for the mother to go full term.

It is also been found that women without health insurance also have a higher incidence of preterm birth. Texas had the worst rates of uninsured women with 34.2 percent without insurance. Florida and New Mexico had rates of uninsured women of about 30 percent. Kentucky had rates of uninsured women of 21.7 percent.
(Read more)

To see the full report and to see how Kentucky fared compared to other states in a number of other categories, go here.

Tuesday, November 13, 2012

Let's start here: Way too much of Kentucky is way too fat. And, let's add this, we drink lotsa sugary beverages.Why, our intake of Mountain Dew alone is legendary. So, here comes some news out of Japan which may have particular interest to Kentuckians: This week, Pepsi will start marketing a new product called Pepsi Special that is special indeed, since it has the blessing of that country's National Institute of Health and Nutrition as a "food for specified health use." That use, you ask? Fat blocking. Let me at it, you say? Hold up, we caution. Pepsi Special is, in a nutshell, Benefiber Pepsi.

According to reporters at the The Atlantic magazine, wheat dextrin is the same additive in Pepsi Special as the one that's sold as Benefiber in the U.S. It's a soluble fiber that "absorbs water as it moves through our intestines and promotes movement of food through the bowel, and contraction of the bowel wall itself." In a 2006 Japanese study, rats that ate wheat dextrin absorbed less fat from their food because, notes the magazine, "It essentially moved right through them."

So, is any of this actually good for you? Dextrin "may increase micronutrient absorption, stabilize blood glucose, lower serum lipids, may prevent several gastrointestinal disorders, and have an accepted role in prevention of cardiovascular disease," experts say. But you still have to restrict your soda intake for any of this to matter. (Read more)

Monday, November 12, 2012

There's new criticism from Kentucky's doctors in an analysis of the state's four-month old prescription drug law, showing that a lot of what state officials have touted as the law's successes were already in the works before the law went into effect.The Courier-Journal of Louisville reviewed state records after Gov. Steve Beshear released figures last month that showed the Kentucky Board of Medical Licensure had disciplined 33 physicians for violating professional prescription standards. Reporter Mike Wynn writes that he "found that 16 of the cases were resolved before the new law took effect
on July 20, and 13 others involved investigations or actions that were
well under way before the law’s implementation.
The administration also reported last month that 18 of the 44 known pain-management clinics in Kentucky have closed or discontinued pain
management services, including 10 after House Bill 1. Still, state
records are unclear if all the clinics were suspected of illegal
prescribing."

“They’ve taken a situation that required a scalpel to cut out the disease and instead they have used a machete,” Gregory Hood, governor of the Kentucky chapter of the American College of Physicians, told Wynn.

Beshear's announcement last month about the bill's almost overnight success also included crediting it for drops in prescriptions being written for pain killers, most notably for oxymorphone, which had a 38 percent falloff.
But, writes Wynn, "Critics of the law say that at least part of those declines are due to doctors denying needed prescriptions to patients because of problems with HB 1." Experts told the paper that oxymorphone, commonly prescribed as Opana, was not readily available in the market during the applicable period because of a reformulation by its manufacturer. (Read more)

The November issue of Kentucky Living magazine, published monthly for member-customers of the state's electric cooperatives, focuses on children's health. Editor Paul Wesslund writes that the stories and statistics on the current state of the state's kids are "scary."

Reporter James Nold Jr. writes that when experts were asked about their concerns for the state, childhood obesity was front and center. The state ties Georgia and Arkansas for the second highest share of children (37 percent) who are obese, and it trails only Mississippi among children 10 to 17. That’s more than one in three kids who are grossly unfit.

Also of concern are Kentucky children's high rates of asthma, abuse, neglect, and cigarette smoking. The numbers for these are so bad and so seemingly out of control now that health professionals would be happy just to see them remain stable in the future, instead of continuously rising.

Nold writes that the experts' urgency on these matters was palpable. A lot of them talked about the way poor nutrition can harm children now and throughout the rest of their lives. They also expressed deep concern for the lack of dental education and care, the need for more exercise and for more parent involvement in all of their children's choices.

The magazine, which has a Health Club for children, notes that the University of Kentucky'sCooperative Extension Service provides nutrition education to students in all 120 counties. For more information on the club, or to join, go to www.KentuckyLiving.com and click on "KL Health Club." (Read more)

Promising results are coming from research that uses patients’ own cardiac stem cells to heal their hearts, a Louisville doctor told colleagues this week at an American Heart Association meeting in Los Angeles.

Laura Ungar of The Courier-Journal reports that Dr. Roberto Bolli, lead author of the clinical trial and chief of cardiovascular
medicine and director of theInstitute of Molecular Cardiologyat the
University of Louisville, said cardiac stems cells may someday be used to treat heart failure caused by muscle scarring after a heart attack.

Bolli, who partnered with Dr. Piero Anversa of Brigham and Women’s Hospital in Boston on the research, explained that their research showed that hearts in patients treated with their stem cells had greater pumping power, and benefits continued to increase as long as two years after receiving the cells. Heart failure afflicts about 6.6 million Americans. (Read more)

It is not just about post-traumatic stress and re-entry into the job market anymore, as if it ever was. In topics as diverse as how to best get electronic medical records to how to treat the severely injured who would not have survived earlier wars, The Praeger Handbook of Veterans Health: History, Challenges, Issues and Developments has plumbed the expertise of 65 professionals -- many with ties to the University of Kentucky -- to teach anyone who cares how it's done.

Mary Meehan of the Lexington Herald-Leader reports that the editor of the four-volume set is Dr. Thomas Miller, professor emeritus and senior research scientist in psychiatry at UK, who began working on the handbook in 2006. The book makes wide use of Miller's many decades of work with veterans as well his network of experts from other countries.

Miller told the Herald-Leader that he hopes the book will not only show people the scope of
services available and how to get the help they need, but help shape the
future of veteran care and by extension health care in the United
States. The set is designed as a resource for libraries, health care offices and universities. It is available at online bookstores for $257. (Read more)

Friday, November 9, 2012

Nearly one-quarter of adults throughout Greater Cincinnati and Northern Kentucky did not always go to the doctor when they needed to during the past year, according to a Cincinnati Enquirer poll. And of those that did seek medical attention last year, a little more than one-quarter (27.5 percent) said they were not able to pay all of their medical bills. The results may not be all that surprising but do highlight health care costs’ impact on the average American.
“It’s very common to see people making decisions between food and medicine,” said Kate Keller, senior program officer at the local policy group the Health Foundation of Greater Cincinnati.

Local doctors say they’re seeing all sorts of ruses from patients to try to avoid even a $25 co-pay.
Rob Tracy, a family doctor at St. Elizabeth Physicians in Cold Spring (left, with patient Kathy Schneider), said some patients call and ask him to call in a prescription to the pharmacy without a visit. That allows them to avoid a co-pay on the office visit. He said delaying such visits only deepens the impact of chronic conditions and ups the costs when those patients are forced to local emergency rooms when their symptoms fail to improve. (Enquirer photo by Carrier Cochran)

Peale notes that these issues are intrinsically involved with the Patient Protection and Affordable Care Act, which was cemented by President Barack Obama's victory Tuesday. It is set to go into full effect in 2014.
"The law will help insure as many as 30 million more people by requiring every American to buy insurance or pay a penalty, requiring employers to offer benefits or pay a penalty, and requiring insurers to accept anyone who applies," Peale writes. With the new law in place, the average person will likely be paying $4,775 out of pocket, including premiums and co-pays. (Read more)

Grandparents might be more quick to say yes to grandkids but they might also be a little behind the times on the the new safety guidelines that could better protect them. A new study finds that many grandparent caregivers don't know about those new health suggestions and, in some cases, laws for babies -- such as appropriate sleep position, crib safety and car seat use. This is particularly critical in a country where 2.8 million grandparents are primary caregivers to their grandchildren, an increase of nearly 20 percent since 2000, according to the the 2011 American Community Survey.

In this study, reporter Robert Preidt of HealthDay writes that 56 percent of grandparents asked got the question about the safest sleep position of babies wrong. (The correct answer is on their backs, according to the American Academy of Pediatrics.) "Another question addressed correct car seat positioning, and 24.5 percent of the participants said that a 9-month-old, 22-pound child should be facing forward. The AAP recommends, however, that children remain in rear-facing car seats until age 2 years." It doesn't get much better. Almost half of those grandparents questioned thought it was OK to have bumpers, stuffed animals and blankets in cribs. It's not.

We know it's difficult but maybe it time to have the talk. (Read more)

Those almost 60 million Americans who live in rural America do not have as much ready access to health care or to the vast number of health care providers than those who live in more urbanized America. Rural Americans are more likely to arrive on the doorstep of health care facilities without insurance, and that number is growing. These challenges and more have prompted the National Organization of State Offices of Rural Health (NOSORH) to designate Thursday, Nov. 15 as National Rural Health Day. The day, explains NOSORH director Teryl Eisinger, is an effort to increase awareness of rural health-related issues. The event has stretched to a week of activities, celebrations and a daily webinar series on rural health-care issues accessible to anyone interested nationwide.

Thursday, November 8, 2012

Nobody's surprised to hear what researchers have now quantified: When children eat out, they take in more calories and fat than they would have at home. It doesn't matter if they're sitting down or driving through, at a fancy restaurant or at a McDonald's, we're not doing them any nutritional favors when we get in the car to go eat.

Jon Bardin of the Los Angeles Times reports that a study, published Monday in the medical journal Archives of Pediatrics & Adolescent Medicine, found that 2- to 11-year olds average an extra 126 calories when they eat a fast-food meal and 12- to 19-year-olds add an average of 309 calories. Full-service restaurants could added an average of 160 and 267 for the two age groups, respectively. And a lot of those calories were of the empty-nutrition kind that come from sugary drinks; kids in the study drank significantly more of those while dining out than when eating at home. (Getty Images photo)

In their report, writes Bardin, the authors argue that government intervention likely will be required to see any improvement: “Public policies that aim to reduce restaurant consumption -- such as increasing the relative costs of these purchases; limiting access through zoning, particularly around schools; limiting portion sizes; and limiting exposure to marketing -- deserve serious consideration.” (Read more)

Oklahoma State University researchers report that they have found a wide range of disease-causing bacteria, fungus and mold on pacifiers that young children had been using.

In research presented at the American Society for Clinical Pathology, scientists have shown that pacifiers can also grow a slimy coating of bacterial film that alters the normal bacteria in a baby or toddler's mouth, increasing the likelihood of colic and ear infections. It gets worse, according to study author Tom Glass, a professor of forensic science, pathology and dental medicine: The same types of bacteria found on a common pacifier have been linked to cardiovascular disease, metabolic syndrome, allergies, asthma and autoimmune diseases.

HealthDay reporters Barbara Bronson Gray writes that Glass said the problems associated with pacificers are also applicable to any removable orthodontic appliance like retainers, mouth guards and dentures. Glass said his researchers were particular concerned about their findings when they discovered that "many of the bacteria growing from the used pacifiers were resistant to commonly used antibiotics such as penicillin and methicillin.
The development of such resistance to certain antibiotics does not cause the organism to be more infectious than other strains that have no antibiotic resistance, but it can make the infection more difficult to treat." Glass told Gray that he does not recommend that pacifier use. use.
"After doing the study, I say why take a risk?" (Read more)

Wednesday, November 7, 2012

Norton Healthcare is the first health-care provider in Kentucky to implement a patient monitoring system that allows obstetricians to monitor expectant mothers while they're in labor via the physician's smart phone or tablet. The real-time application uses wave-form technology and works with iPhones, Androids, BlackBerrys and a variety of Windows Mobile devices. Its use has been cleared by the U.S. Food and Drug Administration.

The implications are vast for doctors in busy urban settings as well as
for those in rural areas where doctor shortages may limit a
physician's personal attention to individual patients. According to Norton Healthcare press materials and their obstetrician spokesperson, Dr. Reed Netter, the application allows the doctor to view "the same patient information that he or she would see at the patient’s bedside, looking at the monitor for heartbeat, contraction patterns, or signs of distress." This could save valuable time when a fetus is in trouble or if nurses see something that worries them.

The applications of the technology are evident for use in ambulances, in intensive care units, operating and emergency rooms, said Steve Heilman, Norton's system vice president and chief medical information officer for Norton Healthcare. (Read more)

The Fifth Annual Horses and Hope Race Day honoring breast cancer survivors will be Sunday, Nov. 18, at Churchill Downs. Hosted by First Lady Jane Beshear and the Kentucky Cancer
Program at the University of Louisville’s James Graham Brown Cancer
Center, it's a day for wearing pink and meeting some local celebs and scientists. Gates open at 11:30 a.m. First post time will be at 12:40 p.m.

The mission of the Horses and Hope program is to increase breast cancer awareness, education, screening, and treatment
referral among Kentucky’s horse industry workers and their families. The day's participants will get lunch and a chance to tell Louisville fashion designer Gunnar Deatherage just what you thought of his work on Season 10 of Lifetime Television's "Project Runway." Also on hand for the more important stuff will be James Graham Brown Cancer Center Ambassador Jessica Rizzo and State Rep. Joni Jenkins, sponsor of 2005's HB 7 which created the state's Breast Cancer Research and Education Trust Fund.

Cost to attend Horses and Hope Race Day is $28 for adults and $18 for children, age 12 and under, and includes admission to the Downs, parking at Gate 10, seating on Millionaires Row Four and the luncheon buffet. Tickets can be purchased from Churchill Downs online or by phone at 502-636-4400. For more information about Horses and Hope Race Day, contact the Kentucky Cancer Program at 877-326-1134 or 502-852-6318.

Monday, November 5, 2012

In a 2011 update of a study done four years ago, the U.S. Department of Health and Human Services Office of Adolescent Health (OAH) surveyed America's teenagers about their physical health and potentially risky behaviors. Broken down state-by-state, the study presents a picture of what ails us, if we are willing to pay attention.

In Kentucky, the numbers read as not terribly surprising. Our kids are a little more fat than the national average. They smoke and chew more tobacco. They have a little more sex while in high school. But one statistic is startling: Kentucky's teenagers are trying to kill themselves more frequently than other teenagers nationwide.

According to data collected by the Centers for Disease Control and Prevention last month, 11 percent of Kentucky youth
have attempted suicide, compared to 8 percent nationally. Moreover, 5
percent of Kentucky's teenagers have had a suicide attempt result in an
injury, poisoning or overdose that had to be treated by a doctor or
nurse during the 12-month period before the survey was conducted. That compares to only 2
percent nationwide for kids responding who required the same treatment during the same duration.

If there is good news for Kentucky in the survey, it's this: The state's teenagers are in reasonably good health, but are not getting the physical exercise that the rest of the nation's teens are getting (39 percent vs. 49 percent) and they are playing fewer team sports (46 percent vs. 58 percent). They are heavier (16 percent vs. 13 percent) than the average American teen and more likely (36 percent to 28 percent) to drink a can, bottle or glass of soda or pop one or more times a day.

They are less likely to have never tried smoking (41 percent to 55 percent) than other American teens, to have smoked on a least one day of the last 30 (24 percent to 18 percent), bought their own cigarettes (21 percent to 14 percent) and used chewing tobacco (17 percent to 8 percent). Eight percent of Kentucky teenagers report using pain relievers for non-medical reasons in the last 12 months. That's a bit higher than the national average of 6 percent of U.S. teens who report doing the same.

Kentucky's teenagers are also a bit more likely to have had sexual intercourse while in high school (52 to 47 percent) than the national average, more likely to carried a weapon on a least one day (23 percent o 17 percent), carried a gun (9 percent to 5 percent), though less likely to have been in a physical fight (29 to 33 percent).

To find each of these topics, go here. Look for the heading (physical health, mental health, substance abuse, healthy relationships), then go to the Kentucky site page. A more complete data picture will emerge.

Voters' choices on Tuesday about who sits in statehouses may matter more in the long run than who they have chosen for president. Two of the biggest provisions of the Patient Protection and Affordable Care Act -- offering Medicaid to more people and setting up state health exchanges -- are in the hands of state officials who can either disrupt implementation of the law or move it forward. In Kentucky, Republicans are pressing to take over the state House and their leader, Rep. Jeff Hoover of Jamestown, has said the expansion would be too expensive, even with heavy federal subsidies.

Maggie Fox for NBC News contrasts the approach of Texas, which has refused
$76 billion in federal matching funds to help it expand Medicaid in the
next five years, to that of Vermont, which is wholeheartedly embracing the expansion.
Texas has 6.3 million uninsured, reports Fox, a quarter of the state's
population and the highest percentage of uninsured people in the
country. "We're not going to part of socializing health care," said
Texas Gov. Rick Perry, a Republican.

“There are states referred to as ‘Hell, no’states,” said David Smith,
an analyst at Leavitt Partners, a health-care consulting firm. And while 11 governorships are on the ballot on Tuesday, “a lot of those states don’t necessarily have governors who are up for election,” said Smith. In
those states, voters have to decide whether to help governors by
electing members of the same party to the state house.

In other states, it's more straightforward. Alabama, Florida, Montana and Wyoming have ballot measures asking residents whether they want to block the mandate requiring people to get health insurance. (Read more)

Almost a decade ago, Dr. Carl Smith Jr. did something that many health care providers across America are still struggling to do: He implemented electronic health records that can be assessed from anywhere in the United States during an emergency.

Because the process is expensive, and Smith works in rural, isolated Harlan County, he earned a trip to Washington, D.C. for this year's White House Health IT Town Hall meeting. The assembly was gathered to discuss progress and barriers on the road toward a national health IT system, reports Nola Sizemore of the Harlan Daily Enterprise.

At the meeting, senior White House officials and Department of Health and Human Services staff asked him about how he was able to accomplish the change from paper records. Smith, a pediatrician, explained how the system works: “Because of this technology, we can send the patient’s prescription electronically by secure email to pharmacies. We can check medical histories, what diseases or medical conditions are trending in the area, and I can voice activate details of the patient’s visit into their record. We can also give patients clinical summaries when they leave our office. We have proved to national governing bodies we can and are doing this.”

Smith added that with the use of electronic records, doctors will be able to access your medical history to see what medications you take, allergies and other pertinent information about your health should you be in an auto accident or suffer injury anywhere in the United States. He said this will especially be helpful if the patient were unable to provide information.(Read more)

Friday, November 2, 2012

Following the nationwide trend of large hospitals taking over smaller ones in light of health care reform demands in a slow economy, Louisville-based Baptist Health added an eighth hospital to its statewide network this week by acquiring Trover Health System in Western Kentucky. Andy Sears, vice president of planning and system development for
Baptist Health, told Laura Ungar of The Courier-Journal that Trover contributed its total assets to
Baptist Health, which took over its liabilities, making the deal worth
about $120 million.

Ungar reports the Trover acquisition is especially understandable in the context of the times. "Experts," writes Ungar, "say one big reason for the
surge is that larger, wealthier
organizations can buy what they need at higher volumes for cheaper
prices. Bigger health care organizations also have greater
might when
negotiating reimbursement rates with insurers." Sears agreed, saying standalone hospitals "don't have the resources to compete."

The deal makes
Baptist Health that state's largest health care provider by total
licensed bed capacity and by geographical coverage. Trover is located in
Madisonville. It will now be called
Baptist Health Madisonville. (Read more)

Passport Health Plan has charged that the state of Kentucky has violated its own bidding process and will spend as much as $80 million more than necessary per year under its new Medicaid managed-care contracts for the Jefferson County region. Tom Loftus of The Courier-Journal reports that the formal letter of protest of the bidding process was filed Thursday. It is the company's response to the recent division of the services of Jefferson County's 170,000 Medicaid recipients to four Medicaid managed-care companies that were once served only by Passport. Loftus writes that Passport is questioning how the region's recipients have been reapportioned. The company says it anticipated a 41 percent share of the region's Medicaid business, but was notified Wednesday that it initially will be assigned only 27 percent. The Cabinet for Health and Family Services released a statement explained that all bidders were aware of the conditions of the contract during negotiations.
(Read more)

Mayo Clinic researchers have found a 33 percent drop in heart attack rates in a Minnesota county after public smoking bans were enacted. This, while rates of hypertension, diabetes, high cholesterol and obesity remained the same or even increased after the ban was put in place, reports The New York Times. The conclusion: “I think the bottom line is this should turn the page on the chapter
discussing whether or not secondhand smoke is a risk factor for heart
attacks,” said Dr. Richard D. Hurt, an author of the study and a
professor of medicine at the Mayo Clinic in Rochester, Minn.

The study, published in Archives of Internal Medicine, was conducted in Minnesota's Olmstead County where medical records were examined 18 months before the county's 2002 public ban went into effect and 18 months after it extended the ban to all workplaces in 2007. (Read more)

The Franklin County Health Department has laid off five employees effective today, four of those are part-time workers. The layoffs are being made in the midst of a $1.7 million drop in revenue from last year. The staff reductions should save the agency $120,000 annually, health department director Paula Alexander told The State Journal. The news comes only two weeks after the Madison County Health Department announced it has been forced to lay off seven workers because of budget shortfalls. Those cuts affected home-health workers in Madison, Estill and Powell counties.

In both instances, department directors have explained that they had expected to receive reimbursements from Kentucky's three Medicaid managed care organizations. A massive increase in those denied claims were reasons both directors gave for their sudden inability to meet budget goals.
Earlier in the year, the Fayette County Health Department lost 25 employees. Faced with similar Medicaid payment issues, several Kentucky counties have tried to cut costs by cutting to a four-day workweek.

Because cardiovascular disease kills more Kentuckians than anything else, and because what mostly kills them is a heart attack, and because if you can get help within 90 minutes of that heart attack your chances improve dramatically, this state needs a vastly improved way to get heart attack patients to the right hospital in a short amount of time. So explains Dr. William Dillon, an interventional cardiologist in Louisville, who writes an guest column in the In The Prime health blog of The Courier-Journal. He punctuates his point with a graph, right, that shows that Kentucky now ranks 49th of 50 states in acute myocardial infarction (AMI) deaths. AMI is doctor-speak for heart attacks. (American Heart Association graph)

Dillon's medically reasoned plea is for a more systematic regional network -- like one that have saved lives in North Carolina -- is "to transfer AMI patients to
dedicated (heart catheterization lab) centers throughout the state." But Dillon also knows that many Kentuckians are not listening to their bodies as closely as they might. He writes that "another source of delay in AMI treatment is that, on average, patients
wait more than 90 minutes before seeking medical attention. Furthermore,
50 percent of AMI patients drive to a hospital or clinic without calling EMS.
Every year, a significant number of these patients needlessly die en
route to the hospital." He adds then that health education -- in this case, early notification of needing EMS help -- is an important component in saving Kentuckians' lives. (Read more)

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!